ABSTRACT
Introduction: Epstein-Barr virus infection with mononucleosis is the most common presentation in young adults. Most infections are self-limited, although in a few cases complications can include serious conditions such as lymphoproliferative disorders or in less severe cases, mild hepatitis. Case report: We present an unusual case of a young male with no liver disease, who presented with markedly elevated cholestatic pattern hyperbilirubinemia, as well as hepatitis. The patient responded well to symptomatic treatments, with spontaneous improvement of the hyperbilirubinemia and transaminitis. Conclusions: Epstein-Barr virus mononucleosis can frequently present with mild elevation of transaminases, but very rarely can have marked elevation of bilirubin, which may make clinicians doubt that the infection is the sole culprit of the process.
ABSTRACT
Colorectal neuroendocrine tumors are rare entities, with large cell neuroendocrine carcinomas occurring less frequently. We report a case of an 83-year-old male who presented with symptoms of intestinal obstruction. A computed tomography scan of the abdomen and pelvis revealed a high-grade large bowel obstruction secondary to an irregular exophytic soft tissue mass within the ascending colon, with extensive metastatic disease. He subsequently underwent a right hemicolectomy. Histologic evaluation revealed large cell neuroendocrine carcinoma of the colon. Standardized treatment modalities have not been established; however, chemotherapy is often used as the first-line or adjuvant therapy with surgery. Unfortunately, our patient succumbed to postoperative complications on day 30 of the hospital stay.
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Gastrointestinal (GI)-predominant myasthenia gravis (MG) is rare and presents a complex clinical scenario. We report the case of a 73-year-old female with dysphagia and intractable nausea found to have bulbar MG. Her symptoms persisted despite conventional MG management with plasma exchange therapy and anticholinergics. We review existing literature and discuss the clinical manifestations, diagnosis, and treatment of bulbar MG. This case highlights the need for novel MG treatment modalities in patients like ours with anomalous, GI-predominant MG who might not respond to conventional management.
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INTRODUCTION: Nodular Fasciitis, also known as infiltrative or pseudosarcomatous fasciitis, is a benign soft tissue tumour of fibroblastic/myofibroblastic differentiation, that was first described in 1955 by Konwaler et al. PRESENTATION OF CASE: This is a case report of a 27-year old male with complaints of a swelling in the right axilla for 2 and ½ years measuring 12â¯cmâ¯×â¯10â¯cm. Chest X-Ray was normal. Magnetic Resonance Imaging of the right arm and chest showed an irregular mass in the axilla in the muscular-subcutaneous plane measuring 10.8â¯cmâ¯×â¯8.8â¯cmâ¯×â¯12â¯cm, with no neural involvement. Magnetic Resonance Angiogram showed feeders from the branches of the Right Subclavian and Right Axillary Artery and venous drainage into the Right Subclavian Vein. USG guided biopsy was done which showed benign spindle cell neoplasm. Patient underwent wide local excision under general anesthesia. The specimen was sent for histopathological examination which showed histological and immunohistochemical features in favour of Nodular Fasciitis. DISCUSSION: Most nodular fasciitis lesions are solitary and occur in adults 20-40 years of age. Nodular fasciitis affects both men and women with equal frequency. Differential diagnosis of nodular fasciitis includes, fibrosarcoma, fibroma, fibrous histiocytoma, and desmoids and histopathology and immunohistochemistry play a key role in identifying the condition. CONCLUSION: Owing to the size, location and findings of the Magnetic Resonance Angiogram we initially suspected a Soft Tissue Sarcoma, but to our surprise, on further investigation the mass was revealed to be Nodular Fasciitis.
ABSTRACT
This is a case report of a rare form of tuberculosis in a patient presenting with dysphagia. Patient was subjected to upper gastrointestinal endoscopy, which revealed an ulcerative growth in the distal esophagus. Histopathology revealed esophageal tuberculosis. Patient was managed conservatively with Anti-Tuberculosis Treatment (ATT). Follow up endoscopy after two months revealed resolution of the growth and patient was symptomatically better. In spite of the rare nature of the disease, it can be managed effectively with ATT to avoid complications (fistula, stricture, and esophageal perforation), which might warrant surgery.
